两段式枸橼酸抗凝在合并高危出血患者行普通血液透析的疗效观察

Observation on the Efficacy of Two-stage Citric Acid Anticoagulation in Patients with High Risk Hemorrhage Undergoing Ordinary Hemodialysis

目的:观察无肝素及两段式枸橼酸抗凝在高危出血患者行普通血液透析中的抗凝效果及安全性。方法:选取2021年1月—2022年12月黔南州人民医院肾病风湿免疫科收治的行血液透析合并高危出血风险的患者78例作为研究对象,共完成112例次治疗,随机将患者分为两组,分别为两段式枸橼酸抗凝组和无肝素组。两段式枸橼酸治疗组为在动脉端给予4%枸橼酸钠溶液,以180~240 mL/h泵入,静脉壶处予4%枸橼酸钠溶液,以80~100 mL/h泵入,治疗结束30 min停止使用枸橼酸;无肝素组采用每半小时生理盐水冲洗管路。观察两组患者透析持续时间、患者透析器抗凝有效性及静脉壶抗凝有效性。观察两组患者治疗前后的血红蛋白、血小板计数、外周血游离钙、凝血酶原时间、活化部分凝血活酶时间、pH值、碳酸氢根、血钠。结果:无肝素组透析时间短于两段式枸橼酸治疗组,差异有统计学意义(P<0.05)。两段式枸橼酸治疗组透析器抗凝有效性及静脉壶抗凝有效性均高于无肝素组,差异有统计学意义(P<0.05)。两组患者透析前后血红蛋白、血小板计数、外周血游离钙、凝血酶原时间、活化部分凝血活酶时间、pH值、碳酸氢根、血钠比较,差异无统计学意义(P>0.05)。结论:对于高危出血风险的血液透析患者,两段式枸橼酸抗凝明显延长透析时间,且无严重不良反应。

Objective:To observe the anticoagulant effect and safety of non-heparin and two-stage citric acid anticoagulant in high risk bleeding patients undergoing ordinary hemodialysis.Methods:A total of seventy-eight patients undergoing hemodialysis with high risk of bleeding admitted to the Department of Nephropathy,Rheumatology and Immunology of Guizhou Province Qiannan Buyi and Miao Autonomous Prefecture People's Hospital from January 2021 to December 2022 were selected as the study objects,and a total of one hundred and twelve treatments were completed.The patients were randomly divided into two groups:two-stage citric acid anticoagulation group and heparin-free group.In the two-stage citric acid anticoagulation group,4%sodium citric solution was given at the end of the artery and pumped at 180-240 mL/h.A 4%sodium citric solution was injected into the intravenous pot at a rate of 80-100 mL/h,and citric acid was discontinued 30 minutes after treatment.The heparin-free group was rinsed with normal saline every half hour.The duration of dialysis,anticoagulant effectiveness of dialyzer and anticoagulant effectiveness of intravenous pot were observed.Hemoglobin,platelet count,peripheral blood free calcium,prothrombin time,activated partial thromboplastin time,pH value,bicarbonate and blood sodium were observed before and after treatment in two groups.Results:The dialysis time of heparin-free group was shorter than that of two-stage citric acid anticoagulation group,and the difference was statistically significant(P<0.05);The anticoagulation effectiveness of dialyzer and intravenous pot in the two-stage citric acid anticoagulation group were higher than those in the heparin-free group,and the difference was statistically significant(P<0.05);There was no significant difference in hemoglobin,platelet count,peripheral blood free calcium,prothrombin time,activated partial thromboplastin time,pH value,bicarbonate and blood sodium between two groups before and after dialysis(P>0.05).Conclusion:For hemodialysis patients with high bleeding risk,two-stage citric acid anticoagulation significantly prolonged dialysis time without serious adverse reactions.